IV stands for intravenous. A healthcare professional administers IV medications, as these medications are not usually something you can give to yourself. This is because the medication goes into a vein, which takes special skill and procedures.
An IV medication can be an injection that is administered through a syringe or an infusion delivered over a period of time. Infusions almost always use a machine to control how fast the medication is delivered to your bloodstream.
Understanding more about IV medications for migraine headaches can help you make confident decisions about your health and well-being.
How IV medications help with migraine headaches
One of the main benefits of IV medications is they work very fast. They work so fast because they deliver medication right to the bloodstream. You do not have to wait for the body to absorb the medication through your stomach. An IV medication will even work faster than one you inhale into your nose or put under your tongue.
IV medications also do not rely on you being able to swallow or keep things down. So, healthcare professionals can use them in people who are nauseous or vomiting, which are common symptoms of a severe migraine episode.
All of this means IV medications can work very quickly to help treat migraine headaches, even if you have nausea or vomiting.
There is also an IV medication that can help prevent migraine episodes.
IV treatments for migraine headaches are most often used in the emergency room (ER). Migraine is a common reason for visiting the ER, especially for people who are not used to getting migraine headaches. Even people who get them on a regular basis may go to the ER if their symptoms are severe or unusual for them.
This section describes some common IV treatments for migraine headache symptoms that you might get in an ER.
It’s normal to receive IV fluids when you are in the ER. When you have a severe migraine episode, nausea may prevent you from drinking enough fluid, or vomiting may cause you to lose fluids and not be able to replace them. This can lead to dehydration. Dehydration can worsen migraine symptoms.
Receiving IV fluids can help correct dehydration quickly. However, it is not clear whether the fluids help the migraine headache get better. Still, fluids are a good idea because they may prevent complications.
Nonsteroidal anti-inflammatory drugs (NSAIDs)
NSAIDs are common pain medications. Many people take them by mouth to help treat pain during migraine headaches. In the ER, you may get an IV NSAID called ketorolac. The usual IV dose of ketorolac is 30 milligrams (mg).
An antiemetic is a drug that treats nausea. Nausea is a common symptom of a severe migraine headache. It can make it hard to take an oral medication. In the ER, doctors may recommend an IV medication to manage nausea and vomiting.
Two common IV medications for treating migraine nausea and vomiting are prochlorperazine and metoclopramide. They are both effective for managing these symptoms.
Specialized IV treatments
Specialized IV treatments are specific for treating a migraine headache itself.
Ergots are drugs that have been around for a long time. There is an IV version called dihydroergotamine (DHE) that can quickly treat a migraine headache. Its side effects can be a problem, especially nausea. So, doctors often pre-treat with an antiemetic drug first.
A 2013 study suggests IV therapy of the drug valproate can be used to stop active migraine headaches.
The Food and Drug Administration (FDA) has approved valproate for the treatment of seizures. In some cases, the drug can be used to treat migraine episodes as well as manic or mixed episodes associated with bipolar disorder.
The use of magnesium may also be an option when considering IV therapies for migraine treatment. A 2020 study suggests magnesium IV therapies can be a safe option for people who cannot receive certain migraine treatments.
Doctors usually try to avoid using IV opioids or barbiturates to treat a migraine headache in the ER. These drugs can lead to overuse headaches and dependence. Plus, they are not as effective at relieving migraine pain as other IV medications.
Prevention with IV medications
One of the newest groups of drugs for preventing migraine headaches is called calcitonin gene-related peptide (CGRP) inhibitors. Most of them are self-injections you administer once a month.
The FDA has approved a preventive drug named eptinezumab (Vyepti) for long-term migraine treatment. It works by blocking the CGRP protein, which can cause migraine headaches. To receive it, you go to your doctor’s office every 3 months for an IV dose.
To learn more about this preventive option as you consider your treatment goals, talk with your doctor to understand the benefits and establish the next steps.
The American Migraine Foundation recommends working with your doctor to create a plan for when your migraine rescue medications are not effective. This can help you navigate an ER visit and the treatments you will receive there.